Organization
FRONTIER DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEN OLDHAM III D.M.D. (DENTIST)
(907) 563-5820
Entity
Organization
Contact information
Practice address
3650 LAKE OTIS PKWY, STE 102, ANCHORAGE, AK 99508-5218
(907) 563-3820
Mailing address
3650 LAKE OTIS PKWY, STE 102, ANCHORAGE, AK 99508-5218
(907) 563-5820
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AA707
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DD7070
—
AK
Enumeration date
07/02/2008
Last updated
07/08/2008
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